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Abortion pills ‘safe and effective’

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bmj, study, pills, abortion, Northern Ireland, Alliance for Choice, Republic of Ireland, citizens' assemblyOnline abortion service is safe and effective way to end pregnancy, finds study.

About a quarter of the world’s population lives in countries with highly restrictive abortion laws, and women in these countries often resort to unsafe methods to end their pregnancies.

And globally, each year an estimated 43,000 women die as a result of lack of access to safe legal abortion services through their countries’ formal healthcare systems. Millions more suffer from complications, according to a study published in the BMJ recently.

Worldwide, the fourth leading cause of maternal mortality is unsafe abortion.

In many countries, a self-sourced medical abortion using pills provides a vital alternative to dangerous methods such as using sharp objects or noxious substances.

Women source mifepristone and misoprostol (or misoprostol alone) themselves and use these medications outside the formal healthcare system.

In some settings, women buy the medications from pharmacies or markets. In others, they self-source using online telemedicine initiatives that provide the medication as well as help and support by email or instant messaging.

One setting in which online telemedicine has dramatically changed women’s access to abortion is in the Republic of Ireland and Northern Ireland.

Abortion laws in both the Republic and Northern Ireland are among the most restrictive in the world.

Abortion is allowed only to save a women’s life and, in Northern Ireland only, if her permanent physical and mental health is threatened.

Although Northern Ireland is part of the UK, the Northern Irish legislature did not adopt the 1967 Abortion Act, which legalised abortion carried out by registered medical practitioners in England, Scotland and Wales.

As a result, in Northern Ireland abortion under most circumstances remains illegal under the Offences Against the Person Act of 1861, which provides a maximum penalty for the woman undergoing the abortion of life imprisonment.

Women from the Republic and Northern Ireland who do not want to, or feel they cannot, continue with a pregnancy have traditionally had three options: those with the requisite financial and logistical means can travel abroad to access abortion in a clinic, while those who do not must either self-induce using an unsafe method or continue their unwanted pregnancy.

For the past decade, however, women of all financial means have also had the option to self-source early medical abortion through online telemedicine.

The results of this study published in the BMJ have important implications for the perception of abortion self-sourced outside the formal health system using online telemedicine the abortion medications mifepristone and misoprostol.

Firstly, they clearly show that not at all abortions taking place outside the law are unsafe abortions.

Secondly, they add an important dimension to existing evidence that women themselves report abortion through online telemedicine as a positive experience with benefits for health and wellbeing.

Millions of women worldwide live in countries where self-sourced medical abortion is a potentially lifesaving option, and strengthening services outside the formal healthcare setting could be a vital component of strategies to reduce maternal mortality from unsafe abortion.

Finally, given the trajectory of abortion policy in Europe and the USA, the visibility and importance of self-sourced medical abortion will continue to increase. There are already reports of women seeking abortion outside the formal healthcare setting in the USA.

Remarking on this research, the Belfast-based Alliance for Choice said that this new study has confirmed  that increasingly, people in Ireland and Northern Ireland are using safe but illegal pills to access the abortions they want but are denied by their out of step legislators.

Speaking about the findings of the study, Kellie O’Dowd, of Alliance for Choice, said: “Often the mainstream media reports wrongly that early medical abortion with pills is unsafe – this study shows that that simply isn’t the case.

“In countries where medical abortion is legal, women are largely unsupervised while taking the pill.

“In the UK, for example, women ingest the first pill at an abortion clinic, but then go home to have their abortion.”

Danielle Roberts, from Alliance for Choice, said that despite the safety of the pills, abortion seekers still need access to professional health care and advice when taking abortion pills: “In the study, we concretely see that the vast majority of women who accessed a medical abortion needed no medical follow up.

“However there is a low risk of complications, and follow up care should be available in Ireland without fear of legal consequences.

“As it stands, women are relying on the British Pregnancy Advisory Service’s (BPAS) helpline established for women in Ireland and Northern Ireland for information on the procedure.”

“Our governments continue to shirk their responsibility to women despite having a clear mandate to introduce proper abortion access North and South, following the results of the Citizens’ Assembly and various reports by human rights watchdogs,” she continued.

“Our politicians are happy to outsource their responsibility to other countries and organisations that provide the abortion pill illegally.

But, as she pointed out, “While we are grateful to organisations like Women on Web and Women Help Women, it is not good enough that women on the island of Ireland get their abortion pills from the Internet.”

Kellie O’Dowd concluded that the criminalisation of abortion continues to put women at risk.

“Women are afraid to access post-abortion care, or to seek assistance during their abortions because of the very real threat of a 14-year prison sentence imposed by legislation in the Republic and risk of life imprisonment under Northern Ireland’s ancient ‘1861 Offences Against the Persons Act’ law.

“Recent raids by the PSNI [the Norhtern Irish police] have made women even more unlikely to seek follow up care,” she continued.

“Our current laws are irresponsible, archaic and out of touch.

“If the physical and mental health of women on this island is being put at risk, it is the fault of our legislators – and not these pills which have been used safely, in both supervised and unsupervised contexts for almost 30 years.

“If our politicians genuinely care about the lives and health of people in pregnancy, then they must legislate for free, safe and legal abortion access.”

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